Injured Employees Face Workers' Compensation Issues

Workers' compensation laws are designed to ensure that employees who are injured or disabled on the job are provided with fixed monetary awards, eliminating the need for litigation. Unfortunately, this need has not been eliminated, and in many states the challenges injured workers are confronting to receive benefits are increasing. The laws are also designed to provide benefits for dependents of workers who are killed because of work-related accidents or illnesses.

In the last few years, injured workers have experienced a massive effort by employers to limit Workers' Compensation benefits. This has directly harmed hard-working people and their families. Improper medical care and attention, and the reduction of benefits, have resulted in poverty, depression, and second-class status for individuals whose only crime was being injured on the job. There are many personal and family tragedies from this unfair treatment and individuals who have been legitimately injured at work need to be treated with respect and dignity and receive the appropriate benefits.

The Occupational Safety and Health (OSH) Act is administered by Department of Labor's (DOL) Occupational Safety and Health Administration (OSHA). Safety and health conditions in most private industries are regulated by OSHA or OSHA-approved state systems. Nearly every employee comes under OSHA's jurisdiction. In addition to the requirements to comply with the regulations and safety and health standards contained in the OSH Act, employers subject to the Act have a general duty to provide work and a workplace free from recognized, serious hazards.

The statutes of this Act cover workers who have been injured while working "within the scope" of their employment. Any injury suffered by an employee at the employer's place of business during working hours is covered, but an injury that is sustained while traveling to or from work usually is not covered. Section 18 of the Act encourages states to develop and operate their own job safety and health programs which OSHA then approves and monitors. Approximately 50% of the states have developed separate state plans. These State Workers' Compensation statutes establish the framework for most employment related injuries.

According to a 2006 report from OSHA approximately 14,000 employers were recently notified that injury and illness rates at their worksites are higher than average and that they need to fix safety and health hazards. OSHA explained that the notification was a proactive step to encourage employers to take steps to improve the safety and health environment in their workplaces. In the case of injuries and accidents that occur at places of employment that OSHA has notified of violations there may be additional legal recovery for the injured employee.

Most employers are required to carry workers' compensation insurance, and in many states heavy financial penalties may be imposed on an employer that does not. In a number of states, there are public uninsured employer funds to pay benefits to workers employed by companies who illegally fail to purchase insurance. In the vast majority of states, workers' compensation is solely provided by private insurance companies. Twelve states operate a state fund and a handful have state-owned monopolies. To keep the state funds from crowding out private insurers, they are generally required to act as assigned-risk programs and can only write workers' compensation policies, while private insurers can turn away the worst risks and can write comprehensive insurance packages.

Workers' Compensation benefits vary from state to state but generally include payments for medical care, partial compensation payments (varies), temporary and permanent disability payments, transportation reimbursement for specific injury related travel and vocational rehabilitation.

It is illegal in some states for an employer to terminate an employee for reporting a workplace injury or for filing a workers' compensation claim. Most states also prohibit refusing employment for having previously filed a workers' compensation claim. However, employers can consult commercial databases of claims data and it would be nearly impossible to prove that an employer discriminated against a job applicant because of their claim history. To avoid discrimination of this type, some states have created a "subsequent injury trust fund" which will reimburse insurers for benefits paid to workers who suffer aggravation or recurrence of a compensable injury.

Some employers vigorously contest employee claims for workers' compensation payments. In any contested case, or in any case involving serious injury, a lawyer with specific experience in handling workers' compensation claims on behalf of injured workers should be consulted. Laws in many states limit a claimant's legal expenses to a certain fraction of an award, payable only if the recovery is successful. However, in certain states this amount is allowed to be as much as 40% or more of the monetary award.

In the vast majority of states, original jurisdiction over workers' compensation disputes has been transferred by statute from the trial courts to special administrative agencies. Within such agencies, disputes are usually handled informally by administrative law judges. Appeals may be taken to an appeals board and from there into the state court system. However, such appeals are difficult and are regarded skeptically by most state appellate courts, because the point of workers' compensation was to reduce litigation. Some states allow the employee to initiate a lawsuit in a trial court against the employer.

Lawyers with specialized knowledge of Workers' Compensation laws should be consulted for advice on how to proceed when an individual is injured on the job. Often this guidance is invaluable and helps ensure that the injured employee receives all of the benefits they are entitled to receive.


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